Provider Demographics
NPI:1720385289
Name:PADDOCK, JOHN RICHARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RICHARD
Last Name:PADDOCK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 PEACHTREE ST NW
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-7022
Mailing Address - Country:US
Mailing Address - Phone:404-874-3498
Mailing Address - Fax:404-874-8305
Practice Address - Street 1:1708 PEACHTREE ST NW
Practice Address - Street 2:SUITE 400
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2434
Practice Address - Country:US
Practice Address - Phone:404-874-3498
Practice Address - Fax:404-874-8305
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-18
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1085103T00000X
GA911103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist